Baseball statistics make a play for health care

Can the sport's information revolution help boost evidence-based medicine?

SAN FRANCISCO (MarketWatch) -- What can doctors and hospitals learn from baseball managers?

Plenty says an increasing number of health-care professionals who are looking at the revolution in baseball statistics -- "sabermetrics" most famously employed by Oakland As manager Billy Beane to build better teams with cheaper players -- to question traditional medical practices and to help develop better and less expensive health care.

It's called evidence-based medicine, and it's the development of best health-care practices based on data that shows which treatments and protocols work and which do not. So far it's generated more interest than adoption among health-care providers who rely solely on their experience and expertise.

Past performance

There are no medical equivalents to baseball stats such as VORP (value over replacement player) or WHIP (walks and hits per inning pitched). But experts say health-care organizations could control costs and improve care if they made greater use of the data that they routinely collect and, for the most part, ignore.

That's where the baseball comparison comes in, says David Merritt, project director for the Center for Health Transformation, an advocacy group founded by Newt Gingrich, the former Georgia congressman and Speaker of the House of Representatives.

"Until you have data on past performance, which hopefully will indicate future performance, it's almost impossible to tell who's going to be a major league ball player and who's not," Merritt says. "A similar analogy can be made to a physician who's treating patients every day and not utilizing the tools and technology of the modern world."

"Billy Beane changed the game," says Stephen Schoenbaum, executive vice president for programs at the Commonwealth Fund, a foundation that supports health-care programs. "It's become a competitive issue to try to do better and better on the data."

The challenge is to invoke the same spirit in health care. Some groups are getting ahead:

In Salt Lake City, doctors at Intermountain Healthcare say a data review of neonatal intensive care showed late-term pregnant women were receiving elective inductions too often. A change in standards has helped them keep the number of expensive caesarian sections below national average while making deliveries safer and less complicated.

In La Crosse, Wis., doctors at Gunderson Lutheran Health System say the high rate of patients using advance directives allows them to save about $2,000 on hospital and physician services per patient in the last six months of life while complying with patients' wishes more accurately.

Changing the culture

Intermountain has been able to hold its rate of surgical C-section deliveries at 19% compared with a 31% national average in part because it examined the impact of elective inductions done at different stages of late pregnancy, says Dr. Brent James, its chief quality officer.

It turned out that babies induced at 37 weeks for nonmedical reasons had a three-fold higher risk of ending up in the neonatal intensive care unit than did newborns induced at 39 weeks, a week before the due date.

"It took us 30 minutes to analyze the data to know we had a problem," James says. "It's the difference between subjective recall and objective data. The expert mind is very good at some things like diagnosis and absolutely useless at summary of [group] experience over time."

Intermountain has one of the most advanced electronic health records in the nation. Doctors and nurses have reliable outcomes data to inform their decision-making about 80% of the time, James says. "We've been able to use that to profoundly change care in our system."

Many doctors new to such computerized inquiries initially worry they'll be hemmed in by rigid guidelines and unable to adapt treatment decisions to individual patients, he says. But they quickly find that data-driven health care doesn't amount to cookbook medicine.

"You end up changing about 5% to 15% of one of our shared-baseline protocols to meet the needs of an individual patient," James says. "Typical physician time to manage these complex cases falls by about 50%. It has a big impact."

Necessary but not sufficient

Medical centers have been focused on improving the biological treatment of illnesses, but broader questions about the use of costly resources remain unanswered, says Dr. Elliott Fisher, director of the Center for Health Policy Research at Dartmouth Medical School.

"Many of them have excellent data systems that would let them try to figure out how to provide better care, but that's not what they're focusing on," he says.

The use of data in health care involves more than determining whether Treatment A is superior to Treatment B. Costs and quality are often driven by judgment calls such as whether a seriously ill patient can be treated at home or needs to be in a hospital. Does a particular patient need a specialist or will a primary-care doctor or nurse do? The gathering and interpreting of evidence on such subjects is in its infancy.

Robust data is necessary but not sufficient to solve health care's ills, Fisher argues. That also requires integrated systems that use electronic health records, performance measurements and payment reform that rewards value over volume, he says.

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